Insulin and glucose infusion could prevent euglycemic diabetic ketoacidosis associated with sodium-glucose cotransporter 2 inhibitors.

Perioperative euglycemic diabetic ketoacidosis (euDKA) is a serious adverse effect of sodium-glucose cotransporter 2 inhibitor (SGLT2i) treatment. We observed perioperative euDKA immediately after discontinuing insulin infusion that was started during surgery in a patient with type 2 diabetes mellitus (T2DM) for whom empagliflozin could not be withdrawn before emergency off-pump coronary artery bypass grafting (OPCAB). Insulin infusion that was started during surgery unexpectedly prevented euDKA until its discontinuation. Therefore, we hypothesized that insulin and glucose infusion initiated at the start of emergency surgery in patients receiving SGLT2is prevents perioperative euDKA. We implemented this strategy during emergency OPCAB in another patient with T2DM who received empagliflozin 2 days before surgery and observed that the patient did not develop perioperative euDKA. With the increasing use of SGLT2is, surgeons may encounter more SGLT2i users who require emergency surgeries. The administration of insulin and glucose infusion in advance emergency surgery can prevent perioperative euDKA.

[Excessive bleeding in the patients with past history of Hassab's operation].

We report two cases of massive perioperative bleeding and multiple organ failure with past history of Hassab's operation. Massive bleeding occurred during laparotomy and thoracocentesis in each case. After Hassab's operation, collateral circulation and coagulation disorders could develop, and unanticipated massive bleeding might occur. Preparations for excessive bleeding and postoperative intensive care would be required for the patients who have past history of Hassab's operation.

[A man with severe dilated cardiomyopathy with implantable cardioverter-defibrillator who underwent sigmoidectomy].

We report a man with severe dilated cardiomyopathy with an implantable cardioverter-defibrillator (ICD) who underwent sigmoidectomy. During the operation, the defibrillation function of the ICD has been stopped to prevent malfunction caused by electrocautery artifacts, and the electrodes of the external defibrillator were placed on the chest wall. Pulmonary artery catheter was inserted under X-ray imaging to prevent the interference between ICD leads and the catheter. Anesthesia was maintained with combined general and thoracic epidural anesthesia. In order to prevent the afterload increase, both milrinone and carperitide were administered. Fluid resuscitation was also performed to maintain circulating blood volume. As a result of the management, patient has not exhibited any heart failure.

Tear film with "Orgahexa EyeMasks" in patients with meibomian gland dysfunction.

PURPOSE: To evaluate the efficacy of a new Orgahexa eye warmer mask for patients with simple meibomian gland dysfunction (MGD) in a prospective comparative study. METHODS: Twenty right eyes of 20 patients with simple MGD, and 22 right eyes of 22 healthy controls were studied. Subjects were allocated to Orgahexa or conventional eye mask wear for 10 min (short-term study), and for 2 weeks (long-term study). Eyelid temperature measurements, slit lamp examination, tear film break-up time, Schirmer test, vital staining, tear film lipid layer interferometry, and dry eye symptomatology scoring with visual analog scales were performed. RESULTS: The Orgahexa eye warmer improved both tear function and ocular surface status, and decreased symptoms significantly without any complications. CONCLUSIONS: The Orgahexa eye warmer is a simple, safe, and convenient method, which seems to improve the ocular surface status and tear functions in patients with simple MGD.

Multiple spatiotemporal patterns of dendritic Ca2+ signals in goldfish retinal amacrine cells.

Although it has been reported that dendritic neurotransmitter releases from amacrine cells are regulated by the intracellular Ca(2+) concentration ([Ca(2+)](i)), their spatiotemporal patterns are not well explained. Fast Ca(2+) imagings of amacrine cells in the horizontal slice preparation of goldfish retinas under whole-cell patch-clamp recordings were undertaken to better investigate the spatiotemporal patterns of dendritic [Ca(2+)](i). We found that amacrine cell dendrites showed inhomogeneous [Ca(2+)](i) increases in both Na(+) spiking cells and cells without Na(+) spikes. The spatiotemporal properties of inhomogeneous [Ca(2+)](i) increases were classified into three patterns: local, regional and global. Local [Ca(2+)](i) increases were observed in very discrete regions and appeared as discontinuous patches, presumably evoked by local excitatory postsynaptic potentials. Regional [Ca(2+)](i) increases were observed in either a single or a small number of dendrites, presumably reflecting the result of dendritic action potentials. Global [Ca(2+)](i) increases were observed in the entire dendrites of a cell and were mediated by Na(+) action potentials or multiple Na(+) action potentials riding on slow depolarization. Ca(2+)-mediated potentials also evoked global [Ca(2+)](i) increase in cells without Na(+) spikes. These spatiotemporal dynamics of dendritic Ca(2+) signals may reflect multiple modes of synaptic integration on the dendrites of amacrine cells.